Provider First Line Business Practice Location Address:
12010 PALM DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESERT HOT SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92240-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-251-6600
Provider Business Practice Location Address Fax Number:
760-251-8587
Provider Enumeration Date:
06/27/2005